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Wearing a wrist splint at night can be beneficial. The best type has a metal shank (photo left, p. 81) that keeps your wrist straight. This straight position maximizes the volume of the carpal tunnel, thereby minimizing the pressure on the median nerve and the flexor tendons. Keeping your wrist straight while you sleep gives swollen tendons a chance to rest. You can find these splints at any sporting-goods store. Over-the-counter anti -inflammatories (ibuprofen, Aleve) can reduce the swelling of the tendons that run through the carpal tunnel. Cutting down on your salt intake is also helpful. Salt makes your body retain water, which can cause additional pressure on the median nerve. If these measures don't improve your wrist in a week or so, or if the initial onset of pain is too bad, see the doctor. Back to Andrew and Ed Following the suggestions outlined above, Ed improved and was back to full duty in several weeks. Andrew continued to have problems, so I ordered a nerve-conduction test to confirm the diagnosis. This test is usually done by a neurologist, who sticks needles into the forearm and records the results of small electrical stimuli. Does the median nerve conduct this electricity across the wrist as it should, or is the stimulus slowed? The degree of slowing indicates the severity of the CTS. Based on my confirmed diagnosis, I injected the carpal tunnel with an antiinflammatory to relieve the swollen tendons and nerve. Several weeks later, Andrew returned to work. These conservative measures-rest and an- ti-inflammatory medications, a splint, a lowsalt diet and an injected anti-inflammatory -didn't help Jerry, a cement finisher. Surgery was indicated, so I performed a surgical procedure called a carpal-tunnel release. This procedure divides the transverse ligament, which forms the base of the carpal tunnel, to decompress the nerve. Carpaltunnel releases are normally an outpatient procedure, and they are over 90% successful in permanently relieving CTS symptoms. Jerry was out of work for a week, followed by three weeks oflight duty. Four to six weeks is the usual time frame for getting back to work after a carpal-tunnel release. Tennis elbow isn't just for tennis players "My elbow hurts too much even to hold a cup of coffee," Bill Schneider told me. "The pain radiates down toward my hand, and I can't hold on to my tools." Bill had just started in Wrist neutral (top photo) is the best working position. Flexing the wrist up or down (inset) while working increases the likelihood of developing carpal-tunnel syndrome. the trades and was constantly carrying lumber and nailing subflooring and roofing. Bill had tennis elbow, or lateral epicondyli- tis. This common complaint is caused by overuse, specifically repetitive gripping. Hammering is probably the most frequent culprit, although I've seen many painters with the same problem. Tightly gripping, particularly with your arms extended, puts a tremendous load on the extensor muscles in your forearm (drawing p. 80). These muscles converge and attach to the bone on the outside of your elbow at the lateral epicondyle. Inflammation of the tendons that attach the extensor muscles to the lateral epicondyle gives rise to tennis elbow. If you catch tennis elbow before it becomes chronic, you can do a lot at home to improve your condition. As with CTS, gentle stretching exercises in the morning are helpful (photos center, right, p. 81). I recommend doing them after loosening the muscles for 10 to 15 minutes in a hot shower. A moist heating pad in the evening may also help. There are several elbow sleeves on the mar- ket designed to help tennis elbow. Most patients find them gratifYing and end up wearing them all day. Avoid working with your arms outstretched, away from your body, which puts more of a load on these muscles. If you've tried the above and are still having problems, you need to see your doctor. He can prescribe or inject anti-inflammatories, or send you to physical therapy. Tennis elbow virtually never requires surgery. However, it frequently takes four to six months to go away completely. Working overhead is hard on the shoulders Scott started losing sleep "because of pain in my shoulder. Now it's constant, and it even hurts to lift my arm without any load. I can't work." A carpenter, Scott had lately been do- JUNE/) ULY 2000 79